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慢性硬膜下血腫鉆孔引流術中沖洗與不沖洗療效對比研究

目的對比分析慢性硬膜下血腫鉆孔引流術中沖洗與不沖洗不同手術操作方法對患者術后療效及并發癥的影響。 方法回顧性收集 2013 年 1 月—2014 年 12 月在四川大學華西醫院神經外科就診的 81 例單側慢性硬膜下血腫患者臨床及影像學資料，患者分別采用鉆孔引流+術中生理鹽水徹底沖洗+術后引流治療（沖洗組 46 例）及鉆孔置管引流不行沖洗治療（引流組 35 例），應用 3D-Slicer 軟件精確測量術后 1 d 顱內積氣量及出院殘余血腫量，對測量數據及并發癥發生情況進行對比分析，并利用術后門診隨訪及電話隨訪資料對比分析血腫復發情況。 結果術后第 2 天沖洗組與引流組患者顱內積氣量分別為（9.98±4.73）、（3.78±1.80）mL，差異有統計學意義（P<0.05）；沖洗組與引流組術后發生新鮮出血概率分別為 6.5%、2.9%，出院前殘余血腫量分別為（9.82±3.20）、（10.94±4.34）mL，血腫復發率分別為 6.5%、8.6%，差異均無統計學意義（P>0.05）。 結論鉆孔引流術中沖洗能快速引流出硬膜下血腫，但明顯增加術后顱內積氣，并可能增加出血風險，且遠期療效與不沖洗組相比無明顯差異，故鉆孔引流無需術中沖洗。由于樣本量及設計學缺陷，尚需大規模隨機對照試驗作進一步驗證。

The Clinical Analysis on Cerebral Infarction after Operation for Subdural Hematoma in Senile Patients

摘要:目的:探討老年慢性硬膜下血腫術后腦梗死的發病特點及防治措施。方法:總結分析21例老年慢性硬膜下血腫術后出現腦梗死患者。結果:多數患者具有高血壓、高血脂、冠心病及糖尿病等多個腦梗死高危因素。術后腦梗死發生于術后1周內者18例,其中3天以內者16例;腦梗死發生于手術區域附近者14例,非手術區域附近者7例,其中5例的腦梗死發生于上述兩個區域。結論:腦梗死發病的高危因素是顱腦術后腦梗死發生的主要原因。Abstract: Objective: To investigate and search for the causes of cerebral infarction after operation for subdural hematoma in senile patients and discuss the remedies for its prevention. Methods: Twentyone senile patients with cerebral infarction after operation for subdural hematoma were reviewed retrospectively. Results: Most of the patients were found to be suffered with several risk factors of cerebral infarction such as hypertension, coronary cardiac diseases, diabetes mellitus and so on. Eighteen cases of infarctions occurred within a week after operation, including 16 cases within 3 days. Fourteen cases of the infarctions located in regions around the operative field, while 7 cases in non operation related area, and 5 cases in both areas. Conclusions: Risk factors of cerebral infarction were the main causes to result in cerebral infarction after operation for subdural hematoma.

Clinical Treatment of Patient with Traumatic Subdural Hygroma

目的:探討外傷性硬膜下積液的治療經驗。方法:對 46例外傷性硬膜下積液患者的臨床資料進行回顧性分析。結果:非手術治療20例。手術治療30例次，其中腰蛛網膜下腔置管持續引流腦脊液5例，鉆孔外引流19例，骨窗開顱蛛網膜撕口4例，積液腔腹腔分流2例。結論:對外傷性硬膜下積液患者，應采取個性化的綜合治療方法。

Analysis on the Related Factors of Recurrence of Chronic Subdual Hematoma after Neurosurgery

摘要:目的:探討慢性硬膜下血腫(chronic subdural hematoma, CSDH)鉆孔沖洗引流術后的復發因素。方法：回顧性分析165例CSDH鉆孔沖洗+閉式引流術的治療效果,并結合患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向等因素進行相關分析。結果:本組治愈151例,血腫復發14例。〖HTH〗結論〖HTSS〗:患者年齡、術后引流量、血腫腔是否有間隔、血腫厚度、引流管安放方向是影響復發的主要因素。Abstract: Objective: To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient’s age,drainage volume,thickness of hematoma, septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence. Conclusion : Age, drainage volume, thickness of hematoma, septal hematoma cavity and direction of drain pipe would affect the prognosis.

癲癇的侵襲性術前評估

癲癇切除手術前精確定位致癇灶至關重要，目前，對于綜合無創性評估仍無法定位致癇灶或區分功能區的患者，國際上常采用硬膜下電極腦電圖監測（Subduralel ectrodes EEG, SDEG）和立體定向腦電圖（SEEG）兩種侵襲性顱內腦電圖（intracranial electroencephalography, iEEG）評估方法進一步定位致癇灶及區分功能區。SDEG 優勢在于其相鄰皮質覆蓋連續性較好、皮層與電極的解剖關系清楚以及功能區定位相對容易；缺點主要在于對深部腦組織覆蓋監測較差、癲癇起源的三維結構難以體現、雙側或相隔較遠的多個區域植入困難以及創傷較大、并發癥比例較高。SEEG 的優點在于定位深部皮質相對容易、癲癇起源的三維結構清楚、微創性高、適合雙側或相隔較遠的多個區域植入；缺點在于相鄰皮質覆蓋連續性較差、功能區定位相對困難、植入過程中可損傷顱內血管導致顱內出血。近年來，iEEG 監測快速發展，但仍需進一步探索，如通過技術的不斷改進及創新實現精確植入電極及降低植入并發癥，通過設計臨床前瞻性研究進一步研究 SDEG 和 SEEG 在定位致癇灶、切除范圍及術后療效的差異等。目前，SDEG 和 SEEG 在術前定位致癇灶方面各有優缺點，臨床上應根據患者的具體情況個體化選擇方案。

One case report and literature review of arachnoid cyst rupture associated with epilepsy

ObjectiveTo review the diagnosis, clinical characteristics and treatment of Arachnoid cyst rupture associated with epilepsy. MethodsThe clinical data of one patient with arachnoid cyst rupture associated with epilepsy was reported and diagnosis, clinical characteristics, the treatment options were discussed with literature reviewed. ResultsWe arranged the operation:arachnoid cyst resection and the left anterior temporal lobe resection and colostomy, the patient recovered well postoperatively, without special discomfort, epilepsy did not attack again. ConclusionsArachnoid cyst rupture associated with epilepsy is extremely rare, postoperative effect is good through strict preoperative assessment.

Management of Chronic Subdural Hematoma by Improved Trepanation and Drainage

目的:改良鉆孔引流術治療慢性硬膜下血腫27例,提高臨床治療效果。方法:術中可控下持續生理鹽水沖洗后,加入尼莫地平注射液排空,術后低滲或等滲液體維持腦灌注壓。結果:27例慢性硬膜下血腫經上述措施處理后,經隨訪均達到滿意臨床治療效果。結論:慢性硬膜下血腫鉆孔引流術中加用尼莫地平注射液沖洗、排氣,及規范化術后處理措施可提高臨床療效。

A comparative study on the value of stereo-electroencephalography and subdural cortical electrodes monitoring in preoperative evaluation of epileptogenic zone: stereo-electroencephalography with less complication of hemorrhage and infection

ObjectiveThe purpose of this study was to compare the value of SEEG and subdural cortical electrodes monitoring in preoperative evaluation of epileptogenic zone. MethodsFeatures of patients using SEEG (48 cases) and subdural cortical electrodes monitoring (52 cases) to evaluate the epileptogenic zone were collected from June 2011 to June 2015. And the evaluation results, surgical effects and complications were compared. ResultsThere was no significant difference between SEEG and subdural cortical electrodes monitoring in identifying the epileptogenic zone or taking epileptic surgery, but SEEG could monitor multifocal and bilateral epileptogenic zone. And there was no significant difference in postoperative seizure control and intelligence improvement (P > 0.05). The total complication rate of SEEG was lower than subdural cortical electrodes monitoring, especially in hemorrhage and infection (P < 0.05). ConclusionsThere was no difference among SEEG and subdural cortical electrodes monitoring in surgical results, but SEEG with less hemorrhagic and infectious risks. SEEG is a safe and effective intracranial monitoring method, which can be widely used.

Analysis of 25 Gerontal Patients with Bilateral Chronic Subdural Hematoma

目的:探討雙側慢性硬膜下血腫(BCSDH)的診斷和治療。方法:對25例老年患者BCSDH的診斷,治療資料總結分析,全部病例均行CT/或MRI檢查。所有患者皆行顱骨鉆孔引流術,其中5例單側鉆孔引流,20例雙側鉆孔引流。結果:全部病例均治愈,隨訪未見復發。結論:CT和MRI檢查是BCSDH的最佳診斷手段。鉆孔引流是BCSDH的有效治療方法。

自發性低顱壓綜合征致小腦扁桃體下疝及硬膜下血腫護理一例